Objectives. To explore some of the demographic risk factors that are associated with the risk of behavioral or emotional problems in children, and to examine the possibility of an association between psychological stress in the parents and psychological problems in their children. Methods. In this study, the presence of psychological stress in the parents and certain psychosocial characteristics that increase the risk of mental problems in childhood were examined in a sample of Uruguayan children from three communities, two urban and one rural. The study, which was carried out in Ciudad Vieja and Barrio Sur, in the city of Montevideo, and in Colonia de Sacramento, a rural town, comprised 115 children between the ages of 5 and 15. Mothers answered the Child Psychiatric Morbidity Questionnaire (QMPI), an instrument for the detection of behaviors pointing to the presence of emotional problems in children. Both parents also supplied the demographic information requested in the Psychiatric Epidemiology Research Interview Demoralization Scale; they answered the CAGE questionnaire, a screening tool for alcoholism; they responded to the Social Support Network Inventory; and they answered questions about their self-perceived mental health. Results. Fifty-three percent of the children had scores greater than 6 on the QMPI, which indicates the possible presence of behavioral or emotional problems. Fathers' self-perception of emotional problems and mothers' feeling of being demoralized showed a statistically significant association with a greater risk of behavioral or emotional problems in their children. Conclusions. In light of our results, mental health in childhood is a social and public health problem that warrants further epidemiologic study in Uruguay.

The Bambuí Health and Aging study (BHAS): prevalence of risk factors and use of preventive health care services Articles

Objective. To describe, for the first time in Brazil, the prevalence of risk factors and the use of preventive health care services among adults 60 years and older. Methods. This population-based study was conducted during 1996-1997 in the state of Minas Gerais, in the town of Bambuí, which is located in the municipality of the same name. In 1996 the town had 14 950 inhabitants. For the study, all the town's residents aged > or = 60 years were selected, along with a comparison sample of persons aged 18-59 years. Data were gathered using interviews and physical examinations. Results. Of the 1 742 inhabitants of the town of Bambuí aged > or = 60 years, 1 606 (92.2%) participated in the interview and 1 495 (85.8%) were examined (blood pressure, anthropometric measurements, and blood tests). Among the 1 020 younger adults selected for the survey, 909 of them (89.1%) participated in the interview, and 820 of them (80.4%) underwent the physical examination. The prevalence of the following risk factors was higher among older adults than among younger adults: physical inactivity (47.7% vs. 28.0%); blood pressure 140-159 mmHg (systolic) or 90-99 mmHg (diastolic) (25.8% vs. 8.7%); blood pressure > or = 160 mmHg (systolic) or > or = 100 mmHg (diastolic) (19.1% vs. 4.1%); total cholesterol > or = 240 mg/dL (40.6% vs. 9.8%); and blood glucose > or = 126 mg/dL (12.4% vs. 2.2%). The daily consumption of fruits and vegetables was similar among the older adults and the younger ones (51.9% and 51.7%), as was also body mass index > or = 25 kg/m² (51.6% and 56.2%). Smoking was lower among the older adults (18.7%) than among the younger ones (31.1%). The proportion of participants whose blood pressure had been checked in the preceding year was high (86.8% among the older adults and 61.2% among the younger ones), suggesting that the high prevalence of uncontrolled hypertension was not due to limited access to health care. Conclusions. For a long time it was believed that the kinds of risk factors that we found in the urban section of the municipality of Bambuí were public health problems only in large Brazilian cities. Around 72% of the municipalities in Brazil have<= 20 000 inhabitants, and these smaller municipalities contain some 19% of the country's entire population. The high prevalence of various risk factors among the older and younger adults in Bambuí indicates a great need for health promotion and disease prevention actions. More research is needed to find out whether our results in Bambuí reflect the reality of other small towns in Brazil.

Improving hepatitis B immunization among high-risk adolescents: a low-cost intervention on the Mexico-United States border Articles

Objective. To analyze factors associated with hepatitis B immunization adherence among adolescents attending a sexually transmitted disease (STD) clinic in El Paso, a city in Texas that is on the border between Mexico and the United States of America. Methods. In this cohort study with 248 adolescents we obtained data on demographics and health beliefs through personal interviews and medical record abstraction. We monitored each of the individuals for 8 months to determine whether the adolescents received a first, second, and third dose of the hepatitis B vaccine. Results. Overall, 32% of the adolescents received the first immunization, 9% the second, and 2% the third. The strongest predictor of receiving either one or two doses was providing the vaccine at the STD clinic as opposed to referring adolescents to a separate vaccination clinic (relative risk (RR) for receiving the first immunization = 7.3; RR for receiving the second immunization = 3.8). Several health beliefs were also associated with receiving vaccinations. Conclusions. The results of our study indicate that hepatitis B vaccination programs can be improved through such steps as providing vaccinations at a convenient site, educating adolescents about hepatitis B risk factors, and emphasizing the difficulty of treating hepatitis B infection.

Dental care for HIV-positive individuals: fear, prejudice, and professional ethics

Objective. To describe the ethical aspects involved in the dental care provided to patients who are HIV-positive or who have AIDS. Methods. Literature review (textbooks and MEDLINE and LILACS databases), with an emphasis on the work developed at the School of Dentistry, Federal University of Minas Gerais, Brazil. We examined the social representation of AIDS, the risk of HIV infection during office visits, the refusal to provide care, referral to other professionals without justification, special charges and office visit hours for HIV-positive patients, and the confidentiality of the serological status of the patient. Results. There is still prejudice and ignorance about the risk of HIV and AIDS infection, on the part of dental surgeons and of patients. Conclusions. An educational project should be undertaken at dental offices and at universities that train new professionals. In addition, the role of national and regional professional associations in providing information concerning ethical aspects involved in the care of HIV/AIDS patients should be reinforced.

Evaluation of exposure to carbon monoxide among kiosk vendors in Valencia, Venezuela Artículos

Objective. To study the level of exposure to carbon monoxide (CO), factors contributing to this exposure, and the exposure's potential effects on the health of vendors who have kiosks located on an avenue with heavy vehicular traffic in the city of Valencia, Venezuela. Methods. We measured the concentration of CO in the air (CO-air) in 16 kiosks in Valencia and also determined the concentration of carboxyhemoglobin (COHb) in the blood of 20 individuals who worked in those kiosks. We also determined the COHb concentrations in a control group made up of 23 professors, students, and workers from Simón Rodríguez University, which is in a town some 120 km from Valencia, in a remote mountainous area without noticeable pollution. Results. In seven of the Valencia kiosks (43.7%) the permissible CO-air limits were exceeded. Among the vendors experimental group there was no correlation between the concentrations of CO-air and of COHb. The COHb average for the experimental group (2.9%) was significantly higher than that of the control group (1.6%) and that of the permissible level, according to the analytical method used (< 1.5%). Of a group of symptoms possibly related to CO exposure that were assessed as to whether or not they occurred on a daily basis, all of these symptoms affected a larger percentage of individuals in the experimental group than in the control group. The most common of these symptoms among the experimental group were fatigue and strong headaches. Conclusions. While the vendors' COHb average does not seem alarming, the CO exposures found could have an adverse impact on these workers' health, especially if they suffered from cardiovascular disorders, or as the result of additive interactions with other environmental pollutants. We recommend carrying out additional studies with more frequent and extended measurements of air quality, to produce information that could be applied in efforts to prevent and control adverse CO health effects.

Antigenic and genomic relation between human influenza A (H3N2) viruses circulating in Argentina during 1998 and the H3N2 vaccine component Articles

Objective. Due to the lack of correlation from 1994 to 1997 between the A H3N2 component of the influenza vaccine recommended for this period and the circulating viruses in Argentina, we decided to study the antigenic and genomic relationships of the 1998 A H3N2 Argentine circulating strains with the corresponding vaccine component for that year as recommended by the World Health Organization (WHO). Methods. We selected 18 influenza A H3N2 strains isolated in Argentina during 1998 to carry out an antigenic and genomic study of their hemagglutinin (HA) and neuraminidase (NA) proteins. For the genomic study we added 3 isolates from Uruguay. We compared the Argentine and Uruguayan strains with available reference strains. Results. We found that all 18 strains from Argentina were similar to the A/Sydney/5/97 (H3N2) strain, as opposed to the A/Wuhan/359/95 (H3N2) strain, which was the vaccine component. This result was confirmed by the genomic study. Conclusions. The approach that we applied in Argentina has improved the quality and quantity of information about influenza in the country. This type of work should be encouraged in other countries in order to help choose the most appropriate vaccine components each year and provide individuals with the best possible protection against influenza.

Control de la resistencia a los antimicrobianos en los hospitales: control de las infecciones y uso de antibióticos Instantáneas

Decisiones diversas Información Farmacológica

International law: an instrument for promoting mental health in the Americas Temas de Actualidad

The standards that have been established by international law for the protection of the basic rights and fundamental liberties of mental patients have unfortunately received little promotion and regrettably have not been used to design or reform current mental health systems. This limited awareness of international standards leads to frequent violations of the basic rights and fundamental liberties of the mentally handicapped, and the dissemination of such standards would therefore foster respect for such rights. It is certainly true that these violations undermine the health of mental patients; thus, disseminating the standards would also help improve the treatment and rehabilitation of affected individuals. International law is thus an essential tool for effective mental health promotion, and its dissemination is essential if general norms and international standards for the protection of mental patients are to be incorporated in national policies, plans, and mental health laws.

Poliomyelitis outbreak caused by vaccine-derived virus in Haiti and the Dominican Republic Temas de Actualidad

In October 2000, the Ministries of Health of the Dominican Republic and Haiti notified two cases of acute flaccid paralysis (AFP) in rural areas, one of them in a 9-month-old female, and the other in a 2-year-old female, respectively. Stool samples that were obtained from these cases, which occurred in July and August 2000, after a 9-year interruption of wild poliovirus circulation in the Western Hemisphere, revealed the presence of type 1 poliovirus. Genetic sequencing, which was later performed at the Centers for Disease Control and Prevention, in Atlanta, Georgia, United States of America, revealed an atypical descendant of the virus used in the manufacture of the oral polio vaccine (OPV), but with 3% genetic divergence with respect to the parent strain. Normally, viral isolates that derive from vaccine components show 99.5% genetic agreement with the parent strain; in wild polioviruses, on the other hand, this agreement is usually less than 82.0%. Thus, the 3% genetic divergence detected in this study suggests that, in areas with low vaccine coverage, the virus used in the vaccine remained in circulation for at least two years, during which it recovered the neurovirulence and communicability of wild poliovirus type 1. This report describes the characteristics and results of the active search for cases of AFP that was sparked by the detection of the two index cases. It also looks at the public health implications of this outbreak for the entire Region of the Americas.